Blue Cross

There are many reasons why we need to overhaul our health care system. This is one of them, and assuredly is big reason why we are spending so much on care, yet have a relatively low life expectancy. We are simply not receiving adequate preventative care, according to a new state governmental report. LAT:

The eight largest plans in the state fail to ensure that their 12 million members are sufficiently tested and treated to prevent and detect major diseases and reduce unnecessary expenses, according to the California Office of the Patient Advocate's report, called the Health Care Quality Report Card.

These are the basics and we are not even getting that right.

The report compared how often the plans, along with about 200 physician groups, met 31 clinical quality standards, such as immunizing infants and screening adults for cancer, in 2006.

It found that almost one-third of middle-aged women hadn't had a mammogram to screen for breast cancer in the last two years, for example, and that almost half of plan members older than 50 hadn't been tested for colorectal cancer.

"As standards of care, they pretty much should happen 100% of the time," said Ted vonGlahn, director of consumer engagement for the Pacific Business Group on Health, which helped prepare the report. "When you look at the averages, it's pretty sobering."

Nobody got four out of five stars. In fact only two managed to get three stars.

Health Net and Kaiser Permanente each received the highest score for overall clinical quality, notching three out of four stars, or a "good" rating.

The rest -- Aetna Health, Blue Cross, Blue Shield, Cigna, PacifiCare and Western Health Advantage -- were given two stars, for "fair."

Plus, consumer groups are arguing even these ratings were overly generous to the HMOs. They left out some pretty important statistical analysis to quality of coverage.

Jerry Flanagan, a patient advocate with the Foundation for Taxpayer and Consumer Rights, said the report let health plans off too easily by failing to take them to task for what he called their "worst behavior."

For instance, he said, the report didn't make note of the cancellation of sick patients' coverage, for which Blue Cross and Kaiser have been sanctioned, or the troubled kidney transplant program at Kaiser.

"This vague and incomplete analysis gives consumers a false sense of security about the quality of HMOs," Flanagan said.

Guess who got two stars for consumer satisfaction? Blue Cross. Shocking isn't it? Lot's of work to do. The government obviously has a role to play in ensuring that these HMOs get the basics right.

One I had a hand in creating that goes after Arnold and another by Its OUR Health Care on Blue Cross.

"Doh! Arnold won't "read or lead" on dirty tricks

The Bright Side of Death

The guys behind It's OUR Health Care just launched a new site called Sick of Blue Cross designed to expose the campaign Blue Cross is waging against reform. They have a letter you can sign to Schwarzenegger and your legislature to tell them to stand up to Blue Cross.

There is a page full of horror stories from consumers of Blue Cross, like this one from Kristina in San Jose:

I went to the hospital a few times for a routine treatment and everything was fine, until I got the bills. The hospital said I didn't have insurance, even though I did. When I called Blue Cross, they told me they would "take care of it." The next thing I know, the bills for those visits were sent to collections.

Now, to add insult to injury, Blue Cross refuses to pay for my daughter's bills. They claim that she does not exist on my policy. I have been trying to fight this for years now, but I've gotten nowhere with them. Blue Cross refuses to pay for the bills, and they claim the "window frame" of responsibility for them has now passed. So now not only is my credit ruined, but so is my daughter's and she's only a minor.

I thought Blue Cross was supposed to protect me when things went wrong, not make things worse.

Go poke around the site. Use their tools to write a letter to the editor. Watch

What another shocking report on dubious Blue Cross business practices. LAT:

BC Life & Health revoked 1,880 individual health insurance policies in California in 2004 and 2005, and a state agency that examined a sampling says it found that more than half the cases it reviewed were improperly handled.

The Department of Insurance said it studied 83 sample cases and issued citations in 49 of them, alleging 67 violations of fair-claims handling laws.

In one case, the department contended that BC Life, a Blue Cross company, told a policyholder in a letter that it rescinded coverage because of an undisclosed medical condition, even though the condition was clearly stated on the individual's application.

In another case, the department alleged that BC Life improperly rescinded a policy after miscalculating the period of time between treatment and the effective date of coverage. BC Life declined to reinstate coverage even after the department brought the error to its attention, according to a report issued by the agency.

When coverage is rescinded, it is as if the policy never existed, leaving the policyholder and healthcare providers to settle outstanding charges.

Blue Cross could be facing up to $670,000 in fines for these violations. It is high time the legislature help them clean up their act. Current regulations have not done enough to deter them from these abhorrent practices.

One of the greatest power of a union is it's ability to lobby as one voice for a large group of individuals. They are advocates for the best interest of their members on a broad scale. The union's activism does not stop at the bargaining table, just as their member's interests do not. Corporation too represent the interests of a group of individuals, their stockholders. Unlike unions they only have on express goal and that is increasing profits. Anything less and they are not fulfilling their legal obligations, which is why it is extremely curious to see this come out of the mouth of a Blue Cross of California's president Brian Sassi:

But Sassi said the firm has an obligation to “fix what is broken and leave the parts that are working well alone.”

“We have an obligation to the 8 million people we serve in California to help inform the debate,” he said.

No Mr. Sassi, you have an obligation to your stockholders to maximize your profits. You are lobbying on their behalf. Blue Cross is not an advocacy organization for its 8 million customers, in fact you would be breaking the law do just that. You are not interested in fixing what is broken, only in preserving or improving your revenue stream. What you term informing the debate thus far has been limited to playing concern troll, in an attempt to preserve the status quo, which benefits your stockholders the most.

You have hired the same firm that produced the "Harry and Louise" ads that sank Hillary Clinton's health care reform proposal in 1994. That is your express purpose here in California, not fixing what is broken with our health care system. You like what is broken. So don't pretend to care about the well-being of your customers. You are not a union.

To "delivering" their "promises to Wall Street." They expect to continue bringing in a 15% profit. After all, they had a 22% growth rate in the past six years. Those are their priorities, not delivering quality affordable health care. Anthony Wright has direct quotes from the President of Blue Cross's parent company Wellstone, bragging about the profits and the "compelling investment opportunity" they are providing for stockholders. It is rather sickening to read and I am not just saying that because the Sicko premiere is tomorrow.

I assume that the movie will touch on something Anthony discuses and that is the "medical loss ratio".

In this health reform debate, people have been talking about the term "medical loss ratio," which is the term for how much money is spent on patient care, rather than administration, marketing, and profit. It's clearly a Wall Street term: How much money is "lost" to patient care? It shows the inverted priorities of an unrestrained industry.

It suggests that whatever insurance companies (or other companies) say to regulators, it is also important to see what they say to investors.

Speaking of health care costs. The NYT has an illuminating article today on paying for increased health care efficiency. Currently there is not a lot of incentive for the health insurance companies to cut cots, other than their "medical loss". When it rests on the doctor's there is little motivation for them to push forward changes. Take electronic medical records for example. It is bloody expensive to pay for all of the computer equipment and few direct rewards to doctors.

The path to saving can be particularly uncertain in the United States’ fragmented health care economy — a mix of risk, regulation and profit in which the incentives are often contradictory. A physician, for example, may try new approaches to trim the costs of providing care, but the results usually benefit insurers more than doctors. Strides in efficiency may be good for society, though there may be scant financial motivation for the doctors themselves.

The NYT highlight's the example of Dr. Richard Baron, who along with his three other physician colleagues spent $140,000 on computers, tablet PCs, servers, software and installation. They made the transition from pen and paper to electronic records, but it has yet to pay off fiscally.

New details about the Blue Cross concern troll campaign are trickling out. It turns out that the print ad was produced by Goddard Claussen. Who you ask?

The ad was produced by Goddard Claussen, the political firm that created the famous "Harry and Louise" ads that helped sink Hillary Clinton's health care reform proposal in 1994. Those ads, funded by health insurance companies, featured a middle class couple raising alarms that Clinton's plan would unleash a confusing national health care bureaucracy.

They are using the same exact fear tactics over again, in attempt to secure their massive profits, while millions go with out care and coverage. Only this time people know exactly what they are up to and are well prepared to parry their attack. Schwarzenegger responded directly to the campaign yesterday, without prompting.

"Blue Cross has already put up an ad where they threaten people and scare people and say `don't change anything,'" Schwarzenegger said during a meeting with high-tech executives at Seagate Technology's office in Sunnyvale. "But we don't pay attention to that."

Actually, you are paying attention quite closely, anything less would be a huge mistake. They were successful back in 1994 and it will take a great deal of effort to overcome their determination to scuttle reform, more than a decade later.

"We always knew there would be people who would like to hold on to the status quo; they don't want changes; they don't want to insure everybody," Schwarzenegger said.

Now that is more accurate. Blue Cross is notorious for cherry picking the healthiest and denying coverage to others. It is among their most odious, but profitable practices.

Anthony Wright has continued to do some excellent fact checking of the wildly inaccurate Blue Cross ads.

Surprising no-one, Blue Cross is emerging as the biggest impediment to health care reform legislation in California. They are transitioning from simple anti-reform rhetoric to full on campaign mode. Blue Cross is playing concern troll. Just check out this language from an upcoming print ad.

"Unintended consequences do happen," the new ad says. "Other states have tried healthcare reforms like 'guaranteed issue' that sounded good. They now have the highest premiums in the country while California has the lowest. Sound familiar? Remember how the rash deregulation of the energy market in California spawned power outages and soaring rates? Let's not go there again."

They are intentionally sowing fear in an attempt to keep the legislature from doing anything to spoil their profit making machine. Salladay rightly points out that the comparisons to energy deregulation are not apt. The deregulation was pushed forward without Capitol insiders really understanding the issue. That is not the case with health care. People are extremely well-informed on the issue and there is a bevy of data to dig into.

Health Access skewers into Blue Cross, calling them Enron in this analogy.